Amey,
I talked with your insurance company and I am faxing back to them Dr. Cottam's history and physical where I have circled the reason's Dr. Cottam states the band needs to come out. This was sent in with the original paperwork, however your insurance stated "we could have missed that originally" so asked I fax it to them again, which I have done. Also I received your message that Jason from the Counseling Center was going to call the insurance and give them his information as well, so I passed that message on to your insurance as well.
Thanks,
Paula
BMI
Dear Amey,
I am very sorry we have not done enough to satisfy your needs. We communicate with you nearly daily and it is not enough for you. Our advice is to get the band out and then pursue obtaining another weight loss surgery in the near future. You obviously do not agree with the authorization experience we see every day with your specific situation. We have stated it is rare for insurance to approve a band removal and change to another weight loss procedure at the same time. The proof is you have already obtained approval for the removal and denial for an additional weight loss procedure. It is not very likely that your insurance will come back and approve both procedures without you meeting their original requirements.
Is it possible that if you show more health problems associated with your weight to get this approved? Yes, but rare. In fact peer to peer has less of a chance of getting approval over taking the time to follow the insurances entire requirements for weight loss surgery after you get the band removed.
I am sorry to state it so bluntly but that is reality. Since you are unwilling to trust our experience in these matters we feel it would be best if you take your services elsewhere. You may want to look into the University of Utah’s program or programs in Boise. You can have them utilize the same approval with your insurance for the band removal.
I will make sure Dr. Cottam sees this email so he knows what is going on.
We wish you all the best,
Darren
Darren J. Cluff, MPA | Practice Administrator
Bariatric Medicine Institute | 1046 E 100 S | Salt Lake City, UT 84102
801-869-7110 Office Direct |
801-869-7130 Fax Direct to my
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From: Paula Larsen
Sent: Friday, July 17, 2015 8:06 AM
To: Amey Nelson
Cc: Darren Cluff
Subject: RE: Insurance
Amey,
I am not in the office today, but able to access my email. I HAVE NOT started an appeal or any peer to peer review yet because I was told you were getting a sleep study test done and I wanted to wait, as per your instructions, for those results before any of this was put in place. So again I have not started either of those yet.
I will copy Darren on this email so that he can respond to the rest of your concerns.
Paula
Bariatric Medicine Institute
From: Amey Nelson
Sent: Thursday, July 16, 2015 4:23 PM
To: Paula Larsen
Subject: Re: Insurance
Please call me asap!!! I have realized that the consent papers Dr Cottam had me sign say LOOP DS. I DO NOT WANT A LOOP DS!!! I just want the STANDARD DS with a commom channel of no more than 125 cm and preferably 100 cm. The insurance submission was for a standard DS but my paperwork says otherwise. I'm confused! What do I need to do to rescind my consent for Loop DS and sign consent for regular DS?
Also...I am having a sleep study done tonight to diagnose sleep apnea. You should be aware that it will take about 2 weeks to get those results.
Absolutely NO peer to peer consultation should take place until I have the correct paperwork signed and I have consulted with Dr Cottam... I have a phone consult scheduled for the 22nd. If Dr Cottam is not willing to do the surgery as a regular DS then there is no point in going forward with an appeal from your office and I will look for another surgeon to treat me. I need to hear this from Dr Cottam not from anyone else!! I have already contacted an attorney for consultation regarding my appeal.
I am extremely concerned by the lack of communication from BMI regarding the lack of returned phone calls and demanding that communication is only done via email. No other professional physician's office does this. Please call me on my cell phone 1st thing in the morning!!
208-680-1618. If I don't hear from you or Darrin then I will assume BMI does not want my business and I will look elsewhere for treatment.
Amey Nelson
On Jul 14, 2015 11:21 AM, "Amey Nelson" wrote:
Thank you so much.. I really appreciate your effort to get this done. I just talked to Jason, the counselor, and he said that when he talked to Blue Cross they told him that they just needed the clinic notes for medical necessity from you guys... Nothing from him. But he sent his notes again to be safe.I'm sure you hear it a thousand times a day but I'm just so tired of being sick and tired. Thank you again... I know you are really busy and this takes extra time away from your other tasks. Thank you!!
On Jul 14, 2015 10:42 AM, "Bariatric Medicine Institute" wrote:
Amey,
I talked with your insurance company and I am faxing back to them Dr. Cottam's history and physical where I have circled the reason's Dr. Cottam states the band needs to come out. This was sent in with the original paperwork, however your insurance stated "we could have missed that originally" so asked I fax it to them again, which I have done. Also I received your message that Jason from the Counseling Center was going to call the insurance and give them his information as well, so I passed that message on to your insurance as well.
Thanks,
Paula
BMI
I have left messages for you for over 3 days with no response. And still I just get emails and no phone calls. Why?
Yes I would like Dr Cottam to do my surgery. Revisions are done in the sane surgery all the time... It is not rare!!! My problem is not worth Dr Cottam's skill but with the professionalism of the office staff.
I have a phone consult scheduled with Dr Cottam in the 22nd. I need to hear from him what the plan is as I feel I am just getting turned in circles from the staff. Thank you for your time.
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